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What Is the Best Treatment for Chronic Neck Pain?
Am Fam Physician. 2004 Mar 1;69(5):1275.
About two thirds of adults report neck pain at some time, but its etiology and optimal treatment remain unclear. Viljanen and colleagues studied the outcome of dynamic exercise or relaxation treatment in nearly 400 Finnish female office workers who had chronic, non-specific neck pain.
The study participants were 30 to 60 years of age and reported nonspecific neck pain of at least 12 weeks’ duration to an occupational health service. After baseline data-gathering and physical assessment, including measurement of cervical range of motion and muscle strength in the neck and shoulders, the 393 women were randomly assigned to treatment or control groups. The 135 women assigned to dynamic muscle training were instructed in exercises using dumbbells three times weekly for 30 minutes over a 12-week intervention period. Relaxation training was provided three times weekly for 12 weeks to the 128 women assigned to relaxation. The remaining 130 women were asked not to change their level of physical activity during the entire one-year follow-up period.
Participants in the intervention groups received one week of reinforcement training six months after randomization. The researchers recorded the level of participation in the assigned program and evaluated participants at three, six, and 12 months. Outcomes monitored included intensity of neck pain, cervical range of motion, dynamic muscle strength, patient perception of ability to work, and number of days of sick leave. Pain and disability were assessed using a standardized rating scale. Depression and work-related stress also were monitored using standardized assessment tools.
Follow-up was complete for 91 percent of participants at three months, 89 percent at six months, and 87 percent at one year. Overall, women in the dynamic training group completed 39 percent of the maximum number of sessions, and those in the relaxation group completed 42 percent. At one year, women spent an average of 31 minutes per week in dynamic muscle training, compared with 20 minutes in relaxation. The control group reported no comparable therapeutic activity. All groups reported reduced intensity of neck pain over time, but the improvement was not significantly greater in either of the treatment groups, compared with women in the control group. Similarly, no significant differences occurred between the groups in neck disability, range of motion, ability to work, or number of days of sick leave. The proportion of women in the dynamic exercise group who perceived full or considerable recovery at six months was 53 percent, compared with 23 percent of those in the relaxation group, and 17 percent of those in the control group. By 12 months, these percentages had fallen to 26, 23, and 12, respectively.
The authors conclude that although patients reported subjectively greater improvement with dynamic muscle training than with relaxation training, neither of the interventions had any clinically meaningful objective effect on nonspecific neck pain. They conclude that patients who maintain normal activities have outcomes equivalent to those of the patients treated with either dynamic exercise or relaxation techniques.
Viljanen M, et al. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ. August 30, 2003;327:475–7.
Copyright © 2004 by the American Academy of Family Physicians.
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